Abstract

Background

Tolerance to enteral nutrition in the critically ill child with shock has not been
studied. The purpose of the study was to analyze the characteristics of enteral nutrition
and its tolerance in the critically ill child with shock and to compare this with
non-shocked patients.

Methods

A prospective, observational study was performed including critically ill children
with shock who received postpyloric enteral nutrition (PEN). The type of nutrition
used, its duration, tolerance, and gastrointestinal complications were assessed. The
65 children with shock who received PEN were compared with 461 non-shocked critically
ill children who received PEN.

Results

Sixty-five critically ill children with shock, aged between 21 days and 22 years,
received PEN. 75.4% of patients with shock received PEN exclusively. The mean duration
of the PEN was 25.2 days and the maximum calorie intake was 79.4 kcal/kg/day. Twenty
patients with shock (30.7%) presented gastrointestinal complications, 10 (15.4%) abdominal
distension and/or excessive gastric residue, 13 (20%) diarrhoea, 1 necrotising enterocolitis,
and 1 duodenal perforation due to the postpyloric tube. The frequency of gastrointestinal
complications was significantly higher than in the other 461 critically ill children
(9.1%). PEN was suspended due to gastrointestinal complications in 6 patients with
shock (9.2%). There were 18 deaths among the patients with shock and PEN (27.7%).
In only one patient was the death related to complications of the nutrition.

Conclusion

Although most critically ill children with shock can tolerate postpyloric enteral
nutrition, the incidence of gastrointestinal complications is higher in this group
of patients than in other critically ill children.